Ghosts in the Machine

How my personal experiences prompted “Prescription: Networking.”

October 20, 2009

When I was a young man and very poor, I lived in West Oakland, a
neighborhood of rundown Victorian houses on the flatlands east of San
Francisco Bay, down by the Port. It doesn’t matter how I came to be
there: in brief, I had nowhere else to go.

This was years after the factories had left Oakland, when crack was
like a plague, and long before the technology boom brought software and
life-sciences companies, a new population that was middle class and
ethnically varied, and developers who built lofts and restaurants for
the new residents. When I lived in West Oakland, on the street where
the Black Panther Huey Newton was shot as he left a crack house one
bleary morning, few of us had regular jobs; the town was mostly
African-American; and, of course, no one had health insurance. When we
got sick, we went to the emergency room of Highland Hospital in East
Oakland.

Once, a feral cat bit through the tendon in my right wrist. When my
arm swelled alarmingly, Kenny D– (who paid for his habit repairing
Chester Street’s cars) drove me to Highland. I waited hours to be seen,
more to be admitted. I wasn’t impatient; there were others in worse
shape. A young man, maybe 15 years old, had been shot in the leg and
was handcuffed to a gurney, a kind of bloody, swollen diaper attached
to his leg. He waited, too, while a fat, bored cop dozed beside him. I
was delirious by the time I got a bed and antibiotics. I spent two
weeks in Highland.

On another occasion, I noticed that the side of my neck was
strangely deformed. Again, I went to the emergency room of Highland.
They scheduled a biopsy. The lump was a tumor, but the harried doctors
were uncertain: was it malignant? Weeks of ineffectual diagnosis
followed. What was strangest of all (and what I don’t understand now)
was that I wouldn’t say or couldn’t remember the genetic condition that
caused the tumor, which I had known about all my life. I was dazed by
poverty and misfortune.

Multimedia

I lived in West Oakland after I had a job and the money to leave,
fixed by some obscure spirit of loyalty. This time in my life made the
strongest possible impression; I have never forgotten it, nor ever
gotten over it. Oakland was my education in sympathy, and it formed
what political feelings I possess. But my experiences there were never
directly reflected in any of the magazines I have edited, which have
been concerned solely with technology and science.

Recently, I saw a PBS Frontline documentary called The Released,
which followed a group of poor, mentally ill men after they were
released from jail. Each left with a bus ticket, $75 in cash, and two
weeks’ worth of medication. The men did badly in homeless shelters and
group homes. They could not find work and did not take their
medications; soon they were back in prison or dead. What reminded me of
my time in Oakland was that none of the hospitals or clinics had
records of which medicines had effectively treated the men’s mental
illnesses, and the men themselves wouldn’t say or couldn’t remember.
They were ghosts. I was badly upset by The Released and wanted Technology Review to ask this question: Is there a technological solution to this small part of our larger health-care troubles?

David Talbot, our chief correspondent, found the answer. Boston
Medical Center (BMC), which serves many of the city’s poorer patients,
has built a network of physician-based electronic records, linking the
hospital with 10 community health centers (see “Prescription: Networking”).
We were eager to learn if the network helped the people it was meant to
help, so Talbot spent days in the emergency room of BMC. There, he met
Vera Sinue, who had been admitted with unstoppable vomiting.

Talbot describes what happened next: “The attending physician,
Aneesh Narang, was understandably worried. He asked if this had
happened before; she muttered that it had happened only in childhood. A
sudden and acute bout of vomiting might … require speedy surgery. …
But Narang called up the electronic records … [and] quickly saw that
Sinue hadn’t told the full story. In fact, vomiting was a chronic
issue; it topped her list of medical problems. … It’s not clear why
Sinue hadn’t disclosed this information. (She later told me she might
have forgotten.) …

[S]uch miscommunication ‘is not really that surprising–we get it
all the time,’ says Andrew Ulrich, an emergency room physician who is
also vice-chair of BMC’s emergency department. ‘You’d be amazed what
people don’t remember.’”

BMC’s network is not sophisticated technology. The electronic
records have neither genomic data nor images. But those records saved
Sinue from a CT scan and a dose of radiation. She was given antinausea
drugs and intravenous fluids. “Once the crisis passed,” Talbot writes,
“a talk with a physician revealed that Sinue was distraught over a
personal issue. When the subject came up, she was overcome with nausea.
She got a referral for what she probably needed most: counseling.”

Often, a technology is “emerging” only in context. But when the
context is suffering, it can make a small but important difference.
Write and tell me what you think at jason.pontin@technologyreview.com.

Tagged

I’m the editor in chief and the publisher of MIT Technology Review. That means I direct the editorial, platform development, and general business strategy of the company’s digital and print publications, as well as our events.… More

Before joining MIT Technology Review in 2004, I was the editor in chief of a now-vanished biotechnology magazine I founded. Between 1996 and 2002, I was the editor of Red Herring magazine, which the Wall Street Journal called the “bible of the dot.com boom.” I grew up on a farm in Northern California, where my mother raised game birds for the restaurants of San Francisco, but I was educated in England, at Harrow School and Oxford University. Consequently, my accent wanders alarmingly.